1+ months

Director, Provider Network Development, Contracting and Provider Relations - Houtson, TX

Houston, TX 77002
  • Job Code
    860797

The Director of Network Development/Contracting & Provider Relations has management responsibility for network development, network contracting, and provider relations in the Houston market under the direction of the Sr. Vice-President of Network Management.  This position is responsible for assisting in the development and execution of local market strategies and action plans as directed by the Sr. Vice-President.  This position is responsible for working cross-functionally with all WellMed divisions in the corporation including operations, legal, marketing, sales, medical management, finance, claims, member services, IT, and facilities to achieve market goals and objectives.  This position will execute and oversee the performance of contracts with payers, physicians, and ancillary services, and seek to resolve operational issues.  In addition, this position will evaluate healthcare analytics to utilize in development, implementation and maintenance of contractual relationships and work with the markets and the Sr. Vice-President to develop new business ventures and markets, and evaluate new business strategies.  This position will further develop policies and controls that will manage the overall operations of each department.  This position will further ensure Enterprise Quick Reference Guides and the WellMed provider manual as well all specialist/ancillary education reflects current WellMed business processes and/or policies. 

 

Primary Responsibilities: 

  • Supports the Sr. VP and market leadership in an effort to sustain professional relationships with contracted physicians and the market leadership to ensure continued market growth. 
  • Maintains a cost effective provider network through careful provider selection, professional contract negotiations and solid operational implementation.  Maintains and updates, through negotiation, all contracts prior to expiration.  Seeks to negotiate changes that reduce financial and legal risks to the organization. 
  • Evaluates proposals for specialists, sub-capitated providers and some ancillary providers and recommends options based on cost and care.
  • Acts as a resource to other internal department payor issues and assures accurate implementation of contracts in addition to working with other departments to assure that contracts are successfully administrated.
  • Works closely with the Sr. Vice-President of Network Management to participate in strategic and operational planning for the WellMed markets and facilitates the execution plan.  Assists in the creation and provides support in the execution of a comprehensive market strategy and a network development plan.  Maintains effective network support services at the corporate level to assure local markets have tools and training necessary to accomplish their objectives.
  • Handles complex provider abrasion encounters striving to ensure that favorable relationships are maintained.
  • Oversees WellMed Quick Reference Guides and Provider Manual as well as in-service educational programs and material to providers regarding WellMed policies and procedures, ensuring all newly added providers are educated within 30 days of executed contract.
  • Monitors, measures and reports on operational issues, opportunities, development plans and achievements within agreed formats and timeframes. 
  • Responsible for supervising and overseeing the performance and facilitates growth and development of all three departments under Network Management to include: Network Development, Network Contracting, & Provider Relations.
  • Performs all other related duties as assigned.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in

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Posted: 2020-01-16 Expires: 2020-03-16

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Director, Provider Network Development, Contracting and Provider Relations - Houtson, TX

UnitedHealth Group
Houston, TX 77002

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